Help: I keep getting tight chest from a variety of triggers.. have argued with doctor the other day...

[NigeWales]

Hi, I visited my doctor a while ago and he suspected that I may have Asthma. He gave me a peak flow meter test (result was 580) and a spirometry lung function test. I was then given an inhaler to use for 1 month and after the month passed I had another peak flow meter test which came out slightly lower (result was 560). Because the 2nd test came out as lower, the doctor told me that I don't have asthma. I was also sent for x rays and all is OK.

My question is this: Is it possible that I could have a case of asthma (even if it is only a slight case) but that the peak flow meter test I had didn't show it (wasn't tested correctly)?

My thinking is that on the day I had the peak flow meter test, my lungs felt great, they were really good that day and I had a high score of 580, then 1 month after I had taken the inhaler daily I had another peak flow meter test, my lungs felt very good again that day and I had a similar results (560).

So could that have been an inaccurate test? How could it show a lung improvement if on the day I took the test my lungs were feeling very good?

580 may actually be the highest score that I'm capable of ever getting, it may be my maximum best.

The test is that after taking an inhaler for a month if my 2nd test was better than the 1st test that would show I have asthma, but it doesn't quite make sense because the day i took the test my lungs were feeling really good.

If I had been tested when my lungs were bad, I may have had a low reading of 450 or something.

Here is some info on my symptoms: I've always been fit and have competed in cycle racing for over 30 years. a couple of years ago I was out cycling in the countryside and went past a few houses that had smoke coming out of their chimneys. It was either coal or wood or similar. The winds were low so the smoke had settled around. I was training hard so was breathing deeply. After I had breathed quite a bit of this smoke in, my chest became really bad and tight, I had a coughing fit that lasted for a while, and I had to ride back slowly to finish the ride. My lungs were tight and painful for hours afterwards.

That was my 1st strange lung experience, the 2nd was when it was someones birthday party in the family and we had a barbecue in the garden, it was one of those small portable barbecue's, the tin foil tray type. I was OK for a while but then my chest started to get tighter and tighter. I asked everyone else if they were OK, and they were all fine and unaffected. When the barbecue smoke came my way each time I felt worse until eventually I had a really bad attack and couldn't stop coughing. I had to get away and was coughing for ages and ages, with my lungs very tight & painful.

My symptoms are that a lot of smells seem to make my lungs go tight/painful and my voice becomes hoarse. Sometimes if there is a lot of pollution around my eyes water and I get a lot of mucus, I have to keep blowing my nose, with chest really tight and aching.

perfume smells, car fumes, clothing detergent, smoke, cooking, frying, chip making, baking, dust, being around a dog, all seem to affect me.

I don't get the bad coughing attacks much but my worry is just wanting know what is wrong with me. I've become very depressed and withdrawn and am suffering from anxiety. I'm so fed up of going to the doctors and thinking that people don't believe me. In all my years of cycling and 1000's of rides I never had an experience where my lungs got affected like they did that day. And since then my lungs get this pain and tightness when certain smells affect them.

When I get a bad chest my family are all OK but they have mentioned to me 'could it all be in your head' and that 'worrying can make people feel ill'. That is what has caused me to become so depressed and withdrawn, having a chest that keeps getting tight and hurting is one thing, but not knowing what it is is the worst of all.

I get confused and irritable and unable to find help anywhere.

One of the worst things that affects me is the pollution from a steel works that is 10 miles away. It's a huge coal burning steel works and if the winds are very low and blowing from that direction, there is a smog build up in the city and the air gets thick, the coal fumes mixed in with it becomes a nightmare for me. When the wind is blowing from that direction, no matter if all the windows and doors are shut I suffer from it. No one else in my family suffer though. Also If there are houses near me burning coal or wood heaters I have to stay indoors.

I've argued with my doctor the other day. I was trying to explain about the steel works pollution and she seemed certain that it is definitely too far away to cause me any problems. she said that out of the 100's of thousands of people in my city why should only I be affected by it. When I told her that perfume smells were causing me problems she asked if I felt unwell today, I replied no I am OK today, she said that there's a lot of deep heat smells in her surgery today so shouldn't I be affected by it.

I was made to feel that I am imagining my symptoms and at one point I got annoyed with her and started to argue with her about it. On a previous visit with her, she had told me that my lung problems were all my own fault because I had smoked many years ago.

Has anyone got any advice so that I could find out what exactly is wrong with me.

[ALUK_Nurses Partner Administrator ALUK Asthma Nurse]

Hi NigeWales,

Sounds like you have a lot going on, it would be helpful to speak to one of the asthma specialist nurses on the helpline as we will be able to advise and support you to make sense of everything.We can be reached on 0300 222 5800 (Mon-Fri,9-5)

Hope that helps,

Asthma UK nurse team

[lakelover]

When I went to the doctors with a bad cough he gave me an inhaler to try for a month. My peak flow was 350 & he wanted it to get closer to 400. He gave me an aerosol type inhaler. When I went back a month later my peak flow had dropped to (about) 240. It turns out that the propellant in the inhaler upsets me. It was a reliever rather than a preventer but as I'd been coughing for 9 months at this stage there was obviously something else going on. I saw the asthma nurse & she gave me dry powder inhalers & the coughing stopped & my peak flow rose. Like you smoke & most smells set me off coughing but my trusty inhaler now does its job. Speak to the asthma uk nurses & they will be able to help with what to tell your doctor, but don't get to withdrawn, it needs sorting.

[hypercat54]

Hi first of all the peak and flow meter is used to test for asthma. The spirometry one is used to check for copd. As asthma is reversible with the right meds your levels should have improved if you had this.

Copd is irreversible and the same improvement wouldn't be shown with the meds. I hope this makes it a bit clearer.

However to complicate things it is very difficult in the early stages of copd to distinguish between asthma symptoms and copd. I have both and they sometimes overlap. Even doctors have problems with this.

It sounds like you are very intolerant of any form of pollution and your previous smoking will have added greatly to that. Many smokers will get copd even years after they have stopped so this is probably the main reason you have it if you do. Ok most copders have been or are smokers and the medical establishment are very good at trying to make us feel guilty and I think use this as an excuse not to research lung disease as aggressively as the other 2 big killers - heart and cancer. Don't beat yourself up though as you have stopped which is great.

I would go back to your doctors and ask if you have copd and if so what stage. If so there is a very good site on here called British Lung Foundation who have members with every lung disease known to mankind though the majority have copd because it is most common. x

[PPxwoods in reply to hypercat54]

In this modern age no asthmatics

diagnosis should be made without

a full spirometry

The other add

Wheeze

Give meds

Wheeze ok is not really an accurate

way to measure

Peak flow at 600 would have a _+

error of 25-50

It is technique dependent

[NigeWales]

Hi, my reading also went down after a month of using an inhalant lakelover, maybe it didn't agree with me.

I did have a full spirometry test done hypercat54 and the results from that were very good. I was told that I don't have anything wrong with my lungs (according to the spirometry). I'm thinking it's more likely a slight case of asthma because the irritants lists I've read for asthma symptoms are the same as the ones that have been aggravating my lungs.

I have now ordered an Airzone Peak Flow Meter earlier from Ebay. I also phoned up the Asthma UK nurse team from the number given above. I explained my symptoms to the nurse and she said that the peak flow test given to me by the doctor could not accurately say that I have or have not got asthma because it was only the 2 times that I was tested with the peak flow meter.

I need to use the meter every morning and evening for 3 weeks or a month and record my results. I can then build up an accurate picture of my lung function.

With the 2 times that I was tested at the doctors, they were only 2 snapshots of my peak flow at them times. Without knowing what my actual maximum peak flow is, it's really hard to work anything out. My maximum could be 580 or it could be 700, I need to keep testing myself regularly and to find this out.

When my chest gets bad again I can also test it to see how I'm affected.

I've been told that morning peak flow can be lower because the lungs are usually worse in the mornings. I have a border collie dog and actually feel better in the mornings after not being with her at all during the night time. It will be interesting to see the results of the peak flow meter.

[hypercat54]

Oh I see. If you look online you can find what your average peak flow should be as it is based on your height, weight, age, sex and race. If you are below the average then you could have asthma. x

[Lysistrata Administrator Community Ambassador]

Hi NigeWales, glad the asthma nurses were helpful. I'm not any kind of professional but was going to say taking 2 random.peak flow readings is not very useful information especially as asthma is a variable condition! I would also add that one set of spirometry also doesn't necessarily tell you that much with asthma - as with the peak flow you don't know what your best is as the predicted results are all based on averages, and on a good day many asthmatics can have good results. My best peak flow is well above predicted and my spirometry used to be too. Things like your fitness levels or playing a wind instrument can also affect your personal best - all that cycling might mean you have a higher normal than other people your age/sex/height.

Perhaps a reversibility test where you do it pre and post Ventolin may be more helpful to see what effect Ventolin has. It sounds like you're already trying to work out your own pattern though and how it responds to triggers.

I also react to many of the same things as you and I definitely have asthma. I feel the GP you saw was not especially helpful. How could she possibly know that no one else in your city is affected by pollution from the works?! Also, as a severe asthmatic i react to many scents but am fine with others which seem equally strong and you might expect to cause problems (eg some perfumes are fine, others are awful). I have never had a problem with deep heat smells btw. I also have a friend with severe asthma who can use spray deodorant while it sets me off majorly; both of us react to paint.

Is there another GP you can see next time? All the data you are collecting will be very helpful if you can sit down with a GP who is willing to listen and discuss what it shows.

[NigeWales]

Thanks hypercat54, I found some charts and mine looks to be about average. I'll try and find my maximum when I get the peak flow meter so I will know for sure

I'm thinking of changing my doctors surgery Lysistrata because they haven't helped me much on this. I definitely won't be seeing that particular doctor again, that's for sure..

paint smells are one of the worst for me too, paint and car exhaust fumes really get to me quickly.

Once I get the peak flow meter I'll let you know how the morning and evening readings are..

[Wheezycat in reply to NigeWales]

Like lysistrata I react on some smells but not others. I am not a severe asthmatic but I still do feel the effect of many scents/smells/VOCs. I don’t get a full attack but I find it very unpleasant. My worst are inscence, smoke (including some wood burners), oilbased paints, Pledge, some perfumy smells. Yes, your GP seemed not so well informed.

[NigeWales in reply to Wheezycat]

I also react differently to certain smells. Cleaning products are really bad for me, also a really bad one is vinegar, this is terrible for me. With paints, I can't use high VOC's at all. I've tried using low VOC paints and some of them are not so good but some are better.

The time I spend using them seems to affect me. I will be fine with no symptoms for maybe an hour, then they start to irritate me.

The last GP i saw was not a good one at all, will never see her again..

[Wheezycat in reply to NigeWales]

I seem so far OK with low VOC paints, but find oil based paints really unpleasant. The place I do some work is in the process of redecorating, and I then need a base in a different part of the building. This sort of thing was never a problem for me until the last two years or less.

[NigeWales in reply to Wheezycat]

Same here, I was fine a few years ago. I could sit around camp fires no problem, never had a problem with coal fumes from houses I cycled past in the country or anything. Nothing really irritated my lungs at all now loads of things seem to be affecting them, I find it really depressing. do you get really down from it all?

[Wheezycat in reply to NigeWales]

Less so right now as it all feels pretty settled right now, but I certainly have periods! Especially when I have been ill with it so everything is hyped up, and my lungs are more reactive. I got quite depressed last time I was really poorly, in September/October.

[Chest1]

Keep a diary of symptoms whilst requesting a second opinion. Your entitled to a second opinion but if you cant get one the quickest way to access help is to ask for a private referral. Your local BUPA or similar will give a quote over the phone. Google the names of the Private hospital chest physicians and you will be able to see their particular field of interest for example asthma, COPD, lung cancer. Good luck

[NigeWales in reply to Chest1]

That's what the asthma nurse I phoned said. She told me that that is the standard way to get a better picture and after 3 weeks 1 months take my reading to the GP and take it from there.

I think with my cycle racing, I do quite well and so get lots of good lung workouts. It's possible that I have the very beginnings of asthma (a slight case) but to me being a cyclist for so long and used to constantly monitoring myself so I can train correctly (less when I've got a cold or been training hard), i'ts very noticeable to me that my lungs aren't right at the moment.

Now I've read that over 40% of pro cyclists develop asthma (inc Chris froome), that's a lot!!

[PPxwoods in reply to NigeWales]

Cycling if you can do it must be

an ideal exercise for asthmatics

Because it is so strenuous it could produce some bronchospasms

and wheeeze

A lot of asthma is exercise induced

but with proper meds this should not be a problem

Use of the blue inhaler before cycling should prove a big help

If it is not helping

you may have to increase the dose

If that does not work

your asthma may also be due

to inflammation of the lungs

And you may need some

Inhaled steroids to control same

Well worth giving everything

right as you can then lead a normal

life

[Superzob]

I think for your own peace of mind you need to move this forward and get a hospital appointment to see a specialist. The difference in your peak flow readings is hardly statistically significant and it is not surprising that you react badly to smokey environments - that seems only natural to me, despite the perceived minimal effect it may have on others. It would be best to seek further professional advice, rather than simply worry about it and make yourself feel worse as a consequence.

[NigeWales in reply to Superzob]

Thanks for the advice Superzob. I'll definitely be moving ahead with my peak flow monitoring and finding out what those results show me.

I've been back and forth to the doctors many times and they are still trying to find out what it is.

Could I ask them for an appointment with a specialist or is it for them to decide this?

[Superzob in reply to NigeWales]

I think you'd be justified in asking for a specialist appointment if they cannot find the cause themselves - after all, that's what specialists are for!

[NigeWales in reply to Superzob]

The last doctor I saw who I argued with because she was implying that I'm imagining my lungs are hurting due to certain smells and pollution. She asked me what do I think may be wrong with my lungs. I said that i think they may be becoming inflamed or something and that's causing the pain.

this doctor then said that she doesn't think the lung pain is caused by smells or anything, and that it's more likely to be food related, because I am also getting bad stomach pains at times so this is what she believes the cause could be.

I think that she mentioned to me that she won't be sending me to a lung specialist, instead she is arranging an appointment with a stomach specialist who will be checking down inside of my stomach to see if they can find anything there.

So basically, even though it is all these smells that are causing my lungs to get bad, and they can also make my stomach ache. And even though if I manage to avoid any triggers, and breath good air my lungs and stomach are good. this doctor thinks it more likely to be food related.

If my memory is correct, even though I didn't actually ask to see a lung specialist, I was told by my GP that they won't be sending me to see one..

[Destiny10]

Nige wales I would have to say go get a second opinion.

[Emer1000]

Stick to the facts get the doctors to sort it out. Get a second opinion. Go to doctor when you have symthoms. Ring the asthma nurse. Facts are facts write them down. Family friends unless they have asthma will not comprehend. They try but they just dont understand it. My voice goes hoarse very hoarse when my asthma gets bad. Eventually I loose the power in my voice and I just can't talk loud.

Perfume, wood chipping, indoor or outdoor smoke makes my chest tight, wear a scarf, avoid these triggers. See if it improves.

Symptoms and triggers can change over time. Ive had to move desk in work some days due to aftershave or perfume, thank goodness open office and I don't have to explain, other days no impact, asthma is inflammtion, it is not the same everyday for me. When my asthma flares up, smoke, freshly cut wood, paint, perfume, aftershave tight chest, painful, hoarse voice, other times no impact. Main action when you have sympthoms is to get away from.what is irritating your lungs. Hoarseness is major indicator for me. It is a constant in my symthoms. Keep asking questions to doc, try a diff one, ring asthma nurse, keep asking questions until some one explains it. Ignore the people who have no medical background and no idea about asthma they can't help explain this.

Ask the doctor for a prescription for blue inhaler, Ventolin, see if it improves symthoms next time. It sounds remarkably similar to my symthom which is why I had to respond.

[NigeWales in reply to Emer1000]

Thanks Emer1000. Reading your post it shows me that with the similarities between us there is definitely going on with my lungs triggered by these smells. When the doctor asked me what I thought it was, I said that it feels as if my lungs are becoming inflamed, feels like they are reacting to certain smells and pollution.

I would like to get an accurate diagnoses, but after reading your post and lots of others on this messageboard (my symptoms seem so similar I could have written many of the posts myself). It's like I have found other people who are like myself. I'm not on my own, there are other like me.

I feel certain that it is living in such a built up city and the pollution that affects me which has probably been the main cause of it. I watched a program once with Ben Fogle, 'New lives in the Wild', one person he went to stay with, who was previously very successful in the city but the pollution affected him so badly his lungs were in a mess. he had serious Asthma and other lung conditions and felt like if he didn't get away that he wouldn't have much longer left to live.

He sold up and moved to Alaska against his doctors wishes, his doctor told him that with his lung condition that the cold would probably make him worse. Luckily he went against his doctors advice and moved away, that was over 25 years ago. and since moving his lungs healed up, he said they have never felt better and that living away from the pollution made them better.

When I get out of the city on camping trips my lungs improve so much. Even if a doctor did diagnose me, I feel that the only 'real cure' would be to live away with cleaner air.

[Emer1000 in reply to NigeWales]

Try salt pipes or Himalyan lamps. Check out Salt centres in Poland too, they get fantastic results. There are salt clinics in Ireland, I expect there must be in UK also. Price here is 35 euro so not excessive. I will try it, Polish friends highly recommend them. Also check US studies on vitamin D and impact on lungs, not enough known here but easy for gp to check if your levels are ok or not.